[Spinal Fusion / Lumbar] Greetings fellow spine patients! (L4/L5 ALIF)

[Greatgreebo]

Obviously I'm new. I've had a L4 L5 ALIF on June 1, 2010. I have Degenerative Disk Disease...meaning, nobody can figure out why my spine went from okay to terrible in such short peroid of time. The neurosurgeon told me I had stage one end plate degeneration at my L4 L5 so it had to be fused.....he said he wasn't worried about the L3 L4 right now because it was only a stage three endplate degeneration (what ever these things means?!?)
I'm a 41 YO Female-field biologist and wildland fire fighter, but I've not had any injurys. It 'just happens sometimes' I've been told by a few doctors. Initially, when all the pain started I was told it is in my head, I needed a psychiatrist, I was just trying to get drugs, I was far to young to have back problems (I look much younger than my 41 years) etc.....They told me about acupuncture and deep tissue massage and I ate Ibuprofen until my stomach bleed. Finally, I got a doctor to listen, he ordered an MRI and had it sent to the head of OHSU Neurosurgery who took one look at it and was like "holy cr@p!!! you need surgery right now!!' (apparantely I didn't need a shrink or yoga.....the problem was real!) I was angry at the time but now I'm just tired.
The reason I tracked this weeksite down:
I was lucky enough to spend the night at the Oregon Health and Science University Hospital just this weekend so they could 'run some tests'.....The pain was SO bad I couldn't breath by the time I got there. I was doing great on week 10 after the surgery but something has gone horribly sideways since then. My PT thinks my L3 L4 is now having major problems due to the strain of having the joint below it welded together. I expected this to happen since my L3 L4 was not in great shape.

so---what is stage one versus stage three endplate degeneration? is it normal to have IMMENSE pain in the joint above the fusion? Will the pain stop or is this a forever cycle I'm on?
whimper.........
Greatgreebo

[Katie]

Welcome to the forum! The more the merrier I'm coming up to the six month mark with an ALIF and XLIF at L4/5/S1 (holy crap! It seems like just a few weeks ago) I was healing famously, then when I started to do more, the pain came back...it felt like it was in the same area and not quite as intense, but enough to wake me up at night. It turned out to be the SI ligaments which have since been responding well to stretching and other therapy.

I would think that it might be a little soon to be experiencing adjacent segment pain. But I know little about such things unfortunately. The body changes so much after surgery...we gain height, etc. I hope it is just a situation where things are still adjusting like I am facing and it gets better soon. I'd check with your surgeon and get another MRI just for safety sake.

And thank you so much for risking everything and fighting those fires. It can be terrifying work (and not so gentle on the body, I'm guessing).

[ajj1001]

It 'just happens sometimes' I've been told by a few doctors.

... that sounds familiar, welcome to the forum.

alison x

[KBear]

Hello and welcome to the forum. I know nothing about endplate degeneration, but am familiar with DDD- as that was part of my diagnosis pre-surgery. Sorry I'm not much help on the other stuff, but I would definitely ask your doctor/surgeon about the extra onset of pain.

[Hooch]

The stages are just a grading of end-plate degeneration, I think there are 3, 3 being the worst.

You better go see your surgeon.

Welcome to the forum btw, I'm sure there are better days ahead for you.

[Justin]

so---what is stage one versus stage three endplate degeneration?

Welcome Greatgreebo!

Here's some great information on Modic changes of the vertebral endplates:

Modic changes, a common observation in Magnetic Resonance Imaging (MRI), are signal intensity changes in vertebral body marrow adjacent to the endplates of degenerative discs. Michael T. Modic, MD, professor of radiology and neurology at Case Western in Cleveland, wrote about these changes in the journal Radiology in 1988, and his name has been associated with these changes ever since.

Modic Changes on MRI

Type I

• Decreased signal on T1, and increased signal on T2.
• Represents marrow edema.
• Associated with an acute process.
• Histological examination shows disruption and fissuring of the endplate and vascularized fibrous tissues within the adjacent marrow

Type II - the most common type

• Increased signal on T1, and isointense or slightly hyperintense signal on T2.
• Represents fatty degeneration of subchondral marrow.
• Associated with a chronic process.
• Histological examination shows endplate disruption with yellow marrow replacement in the adjacent vertebral body.
• Type I changes convert to Type II changes with time, while Type II changes seem to remain stable.

Type III

• Decreased signal on both T1 and T2.
• Correlate with extensive bony sclerosis on plain radiographs.
• Histological examination shows dense woven bone; hence, no marrow to produce MRI signal.

Source: click here.

Click here for more information on Modic changes.

is it normal to have IMMENSE pain in the joint above the fusion? Will the pain stop or is this a forever cycle I'm on?

In my honest (non-medical opinion), "immense" pain is not normal. However, it sounds like the physicians at OHSU recently saw you for your pain. What did they have to say regarding your symptoms? In regard to ongoing pain--it's difficult to say as perception of pain is very unique from one person to the next. Most "pain cycles" do break with physical therapy and time. The key is to make your spine a priority, as you are still very early post-op.

Once again, welcome and we are here to help.

[Wishful Runner]

I just had an ALIF at L4-L5 on September 2nd. They also reinforced from the front the PLIF I had at L5-S1 four years ago. After the first surgery I was told that it is possible the fusion can cause the next level to have problems, especially if the person does not take proper care of themselves by walking everyday to develop the back muscles. It is also important to develop strong core muscles all around and to use proper body mechanics to avoid things like the problem I just had. With business you are in, you are probably in good physical condition so that should help you along.

As far as having that kind of pain so soon after your ALIF, like others have said, you should see your doc's, cause that does not sound normal at all.

Best wishes to you and I hope you find relief soon. It's out there!